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Vitamin D and Chronic Pain

Many people throughout the world suffer from chronic pain. The exact locations of the symptoms and the causes of the discomfort vary widely. Determining the origin of inflammatory processes can often be elusive. Therefore, doctors and patients alike generally turn to powerful medications to alleviate physical suffering. This is, of course, understandable and sometimes necessary. But there is new research that may offer an innovative tool in the fight against many pain related conditions. It turns out that the answer may lie in a simple blood test, some added sunshine and an inexpensive nutrient known as vitamin D.

A study from the July 8th edition of the journal Headache caught my attention. The trial in question was a combined effort of the Department of Neurology and Psychiatry at the Medical College in Baroda, Gujarat, India. The focus of the research was to determine whether vitamin D deficiencies play a role in “chronic tension-type headaches”. To test this theory, 8 patients with both osteomalacia (vitamin D deficiency) and chronic tension headaches were administered both calcium and vitamin D. All of the participants demonstrated a rapid improvement in headache symptoms. In fact, the symptomatic gains were exhibited even before blood levels of vitamin D reached a normal level. It should also be noted that all of the participants did not respond well to previously administered conventional therapies. (1)

Unfortunately, there really hasn’t been a great deal of scientific study about the connection between vitamin D (and calcium) and alleviation of headache pain. The only other experiments that I could find date back to 1994. Both of these papers focus on the ability of vitamin D and calcium to reduce the duration and frequency of migraines in both pre and postmenopausal women. (2,3)

But the headache research got me thinking. What other types of pain might vitamin D (cholecalciferols) be able to relieve naturally?

Back Pain - A recent case study review in The Journal of the American Board of Family Medicine points to vitamin D supplementation as a potential aid for those with chronic back pain, even when caused by failed back surgery. In looking at 6 published cases reports, the authors of this summary determined that bringing vitamin D levels up to a minimum of 80 nmol/L brought about “significant improvement or complete resolution of chronic LBP (lower back pain) in these patients”. They even mention that pain resolution could come about within a relatively short treatment period (4 weeks). The typical dosage required in these patients ranged from 4,000 – 5,000 IUs of vitamin D3 per day. Some research indicates that a lack of vitamin D may play a bigger role in female back pain than in their male counterparts. (4,5)

Female Specific Pain - In some circumstances, women appear to be more sensitive to vitamin D deficiencies and more responsive to “repletion therapy” than men. For instance, higher levels of D have been shown to support cartilage structure and reduce knee pain in women with osteoarthritis. A condition known as “chronic widespread pain”, which involves both physical pain and psychological distress, has recently been linked to a lack of vitamin D in a large population study conducted on British women. Muscle weakness and muscle pain in the back, hips and lower limbs have been noted in women with minimal sunlight exposure and vitamin D intake. (6,7,8,9)

Fibromyalgia -An April 2009 trial determined that fibromyalgia patients with the greatest degree of vitamin D deficiency exhibited higher levels of muscle pain and depression. When they were given vitamin D supplements (50,000 IUs per week, for 8 weeks), significant improvements in “fibromyalgia assessment scores” were found. Those given placebos did not report any benefits. Other studies have also found lower levels of vitamin D in myalgia sufferers. One study that will be published in next month’s edition of Clinical Rheumatology demonstrated a 90% “clinical improvement” in muscle pain in a group of women being treated at a musculoskeletal treatment center. (10,11,12)

Generalized and Specific Pain - A 2008 study determined that patients at a pain clinic with the lowest levels of vitamin D required larger quantities of pain medications. Those with the lowest levels of D also required longer term use of pain relieving drugs (71 months vs. 44 months). Inadequate vitamin D may also be a factor in the pain experienced by those with diabetes undergoing hemodialysis (due to kidney failure). In addition, a recent trial found that supplementing the diets of type 2 diabetics with vitamin D helped to reduce neuropathic pain symptoms such as burning, numbness, tingling and “throbbing sensations”. (13,14,15)

You may think that a vitamin D deficiency is a relatively rare occurrence. But in recent years, several disturbing population studies have indicated otherwise. A recent analysis of six regions of the world (Africa, Asia, Europe, Middle East, Latin/North America and Oceania) found that vitamin D concentrations below 75 nmol/L were very common. D levels below 25 nmol/L were most commonly found in the Middle East and South Asia. Older individuals and those with darker skin pigmentation appear to be at particular risk for deficiencies as well. This is likely due to limited access to sunlight (in the elderly) and a reduced ability to synthesize vitamin D via sun exposure in those with more melanin (a protective pigment found in the skin). (16,17,18,19,20)

The only real way to determine your vitamin D status is to have an inexpensive blood test performed. You simply can’t rely on your recollection of how much sun exposure you get as an accurate measure of the amount of D that is present in your body. Dr. William Davis, a well known integrative cardiologist, recently commented that many of his well tanned patients were deficient based on 25-hydroxyvitamin D blood testing. If your doctor is unable or unwilling to order a vitamin D test, you can easily purchase one yourself via the Internet. (21)

The following generalized advice is provided by Dr. John Jacob Cannell of the Vitamin D Council, “If you use suntan parlors once a week or if you live in Florida and sunbathe once a week, year-round, do nothing. However, if you have little UVB exposure, my advice is as follows: healthy children under the age of 2 years should take 1,000 IU per day—over the age of 2, 2,000 IU per day. Well adults and adolescents should take 5,000 IU per day. Two months later have a 25-hydroxy-vitamin D blood test, either through ZRT or your doctor.”

Start supplementing with vitamin D before you have the blood test. Then adjust your dose so your 25(OH)D level is between 50–80 ng/ml, summer and winter. But remember, these are conservative dosage recommendations. Most people who avoid the sun—and virtually all dark-skinned people—will have to increase their dose once they find their blood level is still low, even after taking the above dosage for two months, especially in the winter.” (22)

Note: “ZRT” is one of the laboratories that offers the 25-hydroxyvitamin D test used to assess overall vitamin D status.

There really isn’t a downside to examining the role that vitamin D *may* be playing in chronic pain conditions. Such an evaluation will do no harm and offers the possibility of a “new” and safer approach to enhancing quality of life and overall health. (23,24,25)

Unfortunately, I didn’t come across any research relating to vitamin D and carpal tunnel syndrome. Perhaps future study will reveal a link. In the meantime, improving vitamin D status may still be worth considering as a theoretical aid in those with CTS.

Being a Steroid, I believe the anti-inflammatory properties of D are self evident. The issue that this fad of D postings really are not taking into consideration is that D is fat soluable requiring bile for emulsification. Bile comes from the liver. Recent studies have shown that 90% of those suffering liver disease are D deficient. The deficiency is not in intake of D but the inability to absorb D in small intestine. Also, D2 & D3 are converted to inactive D25 in the Liver. Take in as much D2 & D3 you care to but w/out high liver and gallbladder function you will not get active Vit D. By the way, the most astonishing health issue not getting air time is Non alcoholic liver disease. Most are walking around with toxic liver and don’t realize the liver is the issue for their health problems.
It is neat to see everyone interested in natural health, but we need to get to the root of the health problems not just ingesting more supplements.

You’d be surprised how common Vitamin D inadequacy still is – even in those without any clinical indications of poor liver function. Most doctors simply don’t test for it and many patients aren’t yet aware of the importance of such testing. Cost can sometimes be an issue as well – Will their health insurance pay? Can the patient afford to spend an extra $50 or so to have the testing conducted independently? Etc.

I frequently discuss the issue of liver function and specifically non alcoholic fatty liver disease. I agree that it’s an important issue to address.

I was diagnosed with chronic pain and prediabetes with neuropathy and vitamin D deficiency this past month. This article has helped me find the info I was looking for: that there’s a chance all conditions may be related. Thanks so much.

I was diagnosed with fibromyalgia several years ago and in the recent months it seemed my symptoms were getting much worse. Luckily, my doctor thought to check my vitamin D levels as I was pregnant and on bed rest much of last year. My daughter is only 5 months old and my UV exposure has been minimal since her birth due to my fibro and her health issues. My levels were at a 2, which my doctor said she has never seen anyone with a level that low. I’m now on 8,000IU a day of Vitamin D and taking one 50,000IU tablet every week until my levels go up.

Thank you for this article, it was quite informative. I have heard though that since I was so depleted of vitamin D that as my levels go up it may cause an increase in pain. Is there any information out there pertaining to pain related to a sudden increase in levels?

BACKGROUND: The current mode of therapy for many patients with musculoskeletal pain is unsatisfactory.

PURPOSE: We aimed to assess the impact of adding 4000 IU of vitamin D on pain and serological parameters in patients with musculoskeletal pain.

MATERIALS AND METHODS: This was a randomized, double-blinded and placebo-controlled study assessing the effect of 4000 IU of orally given vitamin D3 (cholecalciferol) (four gel capsules of 1000 IU, (SupHerb, Israel) vs. placebo on different parameters of pain. Eighty patients were enrolled and therapy was given for 3 months. Parameters were scored at three time points: prior to intervention, at week 6 and week 12. Visual analogue scale (VAS) scores of pain perception were recorded following 6 and 12 weeks. We also measured serum levels of leukotriene B4 (LTB4), interleukin 6 (IL-6), tumor necrosis factor alpha (TNFα) and prostaglandin E2 (PGE2) by ELISA.

RESULTS: The group receiving vitamin D achieved a statistically significant larger decline of their VAS measurement throughout the study compared with the placebo group. The need for analgesic ‘rescue therapy’ was significantly lower among the vitamin D-treated group. TNFα levels decreased by 54.3% in the group treated with vitamin D and increased by 16.1% in the placebo group. PGE2 decreased by39.2% in the group treated with vitamin D and increased by 16% in the placebo group. LTB4 levels decreased in both groups by 24% (p

CONCLUSION: Adding 4000 IU of vitamin D for patients with musculoskeletal pain may lead to a faster decline of consecutive VAS scores and to a decrease in the levels of inflammatory and pain-related cytokines.

The effect of vitamin D supplementation on pain, quality of life, and nerve conduction studies in women with chronic widespread pain.

The aim of this study was to investigate the effects of vitamin D supplementation on pain, quality of life, and nerve conduction studies (NCSs) in women with chronic widespread pain (CWP) diagnosed with Vitamin D insufficiency. Thirty-three female participants with CWP and vitamin D insufficiency were included in this open-label trial. They were evaluated by routine NCSs in upper and lower limbs, pain scales, and the Nottingham Health Profile before and 8 weeks after starting vitamin D supplementation therapy. The P-value was adjusted to account for the number of comparisons performed in each assessment. After 8 weeks of treatment, participants reported significantly lower pain scores (P=0.000). The total Nottingham Health Profile score and subscores for pain, emotional reactions, and physical activity domains were significantly lower (0.000≤P≤0.008). However, no statistically significant changes in NCSs were detected, except trends toward increases in the amplitudes of left median and ulnar sensory nerve potentials and a decrease in the distal latency of the right median sensory potential (0.01≤P≤0.04). Vitamin D supplementation therapy decreased pain and increased quality of life without significantly affecting nerve conduction in patients with CWP.

Be well!

JP

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